Early Hypocalcemia in Pediatric Major Trauma: a Retrospective Cohort Study

Background: Early hypocalcemia is common in adult major trauma patients with an estimated incidence of over 50% and has been linked to death, coagulopathy, and transfusion requirements. However, the incidence and consequences of hypocalcemia in pediatric major trauma have not been investigated. We aimed to explore the incidence of early hypocalcemia in severely injured children.

Methods: We conducted a retrospective cohort study at a pediatric level-1 trauma center. Pediatric major trauma patients, defined as an Injury Severity Score (ISS)> 15, admitted following trauma team activation from January 2010 to December 2020 were included. Patients were classified into three groups: severe hypocalcemia (iCa<1), hypocalcemia (11.15). We investigated the incidence of early hypocalcemia and its potential association with injury severity, transfusion requirements, length of stay, and death.

Results: During the study period, 111 children were identified. Hypocalcemia was found in 19.8% (22) and severe hypocalcemia in 2.7% (3) patients. Hypocalcemic patients did not differ from patients with normal iCa level with respect to demographic or laboratory parameters. Although not reaching statistical significance, hypocalcemic pediatric trauma patients had higher ISS, a more prolonged length of stay, a more frequent need for blood transfusion during first 48 hours, and higher mortality rates compared to normocalcemic casualties.

Conclusion: The incidence of major trauma-associated early hypocalcemia is lower in children than previously reported in adults. Although our study was not powered to detect an association with poorer outcomes, pediatric patients with early hypocalcemia may be at risk of increased morbidity and mortality.